Transcripts For SFGTV Health Commission 4516 20160408

Zsfg was called a part of the vital infrastructure and the new Trauma Center was one of the best real estate deals in 2016 and was given by the San Francisco business times. We also had a Homeless Council award given to dr. Michelle snyderman and the recipient of the medical respite award by success for the Homeless Council and this award recognizes those that delivered outstanding medical Respite Services in the communities and evidenced by the in tact and improved quality of life for home experiencing homelessness and this will be presented in Portland Oregon in the end of may. Mayor lee announced the new Navigation Center march 23 and the city will open the Navigation Center at least additional 200 units for homeless individuals. This center will be begin accepting clients in two months. The department provides the roving medical team for the Navigation Center and the Navigation Center is located at the civic hotel right off of market street. And just the last we heard a lot about this at our contract meeting previous to this meeting is the expansion of the exposure of the prophylaxis from the health net work and provided trainings to hundreds of providers to make sure theyre given guidance for prep evaluation and monitoring the Prep Services for patients and their own medical so we wanted to acknowledge that as well. Thats the end of my report and there other reported items and i am happy to answer any questions that you have commissioners. Thank you. Commissioners, any questions to the director on the directors report or other items to the director . Thank you director. Seeing none we will proceed to the next item please. Yes item 4 is general Public Comment and there is a request. Yes. We have one general Public Comment, Ronnie Robinson please. I believe hes outside speaking to mr. Pictins. Yes. Mr. Robinson. I will put three minutes on the timer and when it beeps thank you very much. My name is Ronnie Robinson and i just spoke with rolan regarding my letter they know youre all aware of and he made he responds and hes going to reply to it immediately. Thank you. Thank you. That is the only request i received. Okay. Thank you very much. So we move on to item 5 which is the report back from the finance and Planning Committee. Okay. Commissioner. Good afternoon commissioners. The finance and Planning Committee met earlier today to approve quite a few contracts and also the contract reports ats been added to the consent calendar. Out of that i want to point the commissioners attention to one of the contracts that was awarded to dr. Kennedy for ken harding. Yeah. Ken harding for the cultural humility training and the actual amount of the two Year Contract should be 500,000 but because we had just listed that as 250,000 we decided that we would still go ahead and add that to the consent calendar, and later on staff will actually adjust the amount to 500,000 for two years, so you know at least we know this way we wont be stalling, you know, the contract from being executed and implemented, and we also have a great presentations about our structures and process of accessing Like Community based organizations performance including how contracts were being written, planned and how our rfps and rfqs are going out so this is the beginning of a multisessions presentation to help us understand how, you know, like contract monitoring, and Quality Improvement are being made to these organizations, so theres also the discussions because todays presentations will focus on the nonprofit agencies and because we also do business with for profit agencies we want to be able to like if theres any difference in terms of how we how we develop contracts and also you know how we manage those contracts, so if people are interested in that subject i think we will have another presentation in the finance and Planning Committee meeting. Any questions commissioners . No. I just want to add that i think its impressive how the team at the department has begun to attack the contract inefficiencies in contracts in a rigorous careful step wise function and i think you never get results quickly on things like this, but over time i think were going to see a lot of it, so i appreciate your leadership on that. Thank you. Any further comments on the finance Committee Report . If not then we will move on to our next item please. Yes, item 6 is the consent calendar. If i can summarize what commissioner chung just said. The last item is a contract with ken harding. If you approve the consent calendar youre approving a contract for 250,000 and dph staff will come back with a contract revision later this year to change the term and the amount but today youre approving if you do so the contract for 250,000. Okay. Thank you. So its before us as a consent calendar if any member wishes to take any item off of the consent calendar otherwise were prepared for the vote. All those in favor of the consent calendar please say aye. Aye. All those opposed . The consent calendar has been adopted unanimously. Thank you commissioners. Item 7 is a resolution recommending that the board of supervisors accept the shares of common shock of vizient inc. Corporated distributed by University Health consortium with uhc mergerace with vha incorporated. Good afternoon commissioners. Greg whiter chief financial officer. So the resolution before you is a step that were are requesting to enter into related to our use of a Group Purchasing organization. As you know the department has under the administrative code and has historically used the University Health consortium as its Group Purchasing organization that allows us to join with other providers to leverage purchasing power for medical equipment and supplies. We use that heavily at both of our hospitals. Were notified about a year ago that uhc had merged with another organization and that the merged entity will be named vizient and that will continue to operate as the Group Purchasing organization for the former uhc members. Under that merger the Corporate Structure that will be in place has changed. In the past under uhc we were members of the organization and we received rebates based on the volume of purchases that we made through the uhc contracts. Under the new Corporate Structure that will be changed, and it will actually go to on owned organization where shares in vizient, the new organization, will be distributed to former uhc members based on the volume of purchasing that they had made through the former organization. So these are not shares that are tradeable on the market. Its a closely held corporation. That could change at some point in the future. If the board were to take an action to change the Corporate Structure but its essentially a way to accept the shares in vizient. They would be held in trust by the treasurers office. The benefit of it it would give as a shareholder the ability to weigh in on certain actions or changes to the operating policies of the vizient organization. There really is no down side to doing it. Its a relatively unusual structure for the city to participate in, but we vetted it, the process with the treasurertaxcollector and the City Attorneys Office so we think its just something that we have to do without down side. Its coming on a little bit of a rush because vizient gave uhc members a deadline to accept these shares so were trying to move it forward through the board of supervisors. We learned late that we needed Commission Approval to do this so we made it a last minute addition to the agenda today planning take it to the board of supervisors tomorrow. I am happy to answer questions to the extent i can if you have them and the City Attorneys Office is here as well. Any sense of how much value there is here . I can ask arnoldo if he has a sense of the value in terms of achievable value. There really is none because theyre not tradeable. There is no way to cash in on that value. Its simply an ownership stake unless the board of vizient makes a change in how they want to redeem the value of the shares. Its just something that we hold that gives us an ownership stake and doesnt have a liquid value to it. So how do you write the letter that says for tax purposes, what is the value of this . Do you know the answer . I will ask the City Attorney to try that one. I am from the City Attorneys Office. Commssioner singer so the par value is basically a dollar per share. There is no actual cash value to the city unless the board of vizient decides to votes to redeem. The current estimated value per share is about 320 per share. Because there is no actual cash value theres really how many shares do we have . So San Francisco general is receiving around 1700 shares. Laguna honda is receiving around 1100 shares. The final number hasnt been determined but it will be added to the joinder and agreement. Could be a lot of money. I mean we will have to wait. Right. The current estimated value at whatever point and time vizient the board of vizient decides to redeem any of these shares for the reasons that are available the value could be more, could be less, depending on since this is a private corporation this is just an estimated value based on their assets and all. While youre here you know you have a recitation of us accepting all of these including all these attachments and exhibits and everything which i am assuming that the City Attorney has actually looked at are just part of the doing business and doesnt put any of us into a liability position. Correct. Actually its recommending that the board of supervisors accept, so the resolution in front of you today is recommending i understand that. But its recommending all of these things here are being approved by the board, and we need to be assured by you that it really is okay because correct. All of these things are in legal language. Exactly. Doesnt exactly tell us what it does. Right, yes. That is correct. Traditionally as common stockholders you have no liability so i think were probably right. As a common stock were not getting any preferred stock. Its all common stock and its a private corporation, so its a corporation. There isnt a liability to the shareholders and the part of the structure. So maybe you could explain that the shares dont really reflect were currently using them as a discount process; right . We purchase our things through there so the shares dont really matter. The same discounts apply. It all works the way it did before. Actually its going to change and thats another issue that were need to discuss with the appropriate individuals. Right now there is no membership fee paid up front. The structure allows for whatever rebates the department or the hospitals were eligible for. The amount, the fee amounts were basically deducted from the rebates received on the back end of the new Corporate Structure which we would have to get into a new agreement once the process changes with vizient. My understanding that vizient will require a payment up front as a membership fee, and the rebates in the back end would be slightly higher, so because youre not deducting those fees from those rebates. [inaudible] go ahead. And just on that point what that would excuse me. What that would require is that we would simply in the budget we would just need appropriation authority to actually pay the membership fee so we would have a neutral swat in the budget that is a modification to appropriation. Thats our expectation so that the net would be the same for us, but it would be just a difference in how the payments flow from us to vizient versus them getting applied as a rebate to the Purchase Price of the equipment that were or the materials that were buying from vizient. Water is on the way. Thank you. [laughter] thank you. Sorry. Any further questions . I move we accept this. Okay. inaudible . Staff recommendation to recommend it to the board of supervisors. Right. Second please. Any further discussion or questions at this point . I will note there has been no request for Public Comment. Okay. Thank you. Then were prepared for the vote. All those in favor of the resolution to recommend to the board to approve this please say aye. Aye. All those opposed . And it has been passed unanimously. Thank you. Thank you commissioners. Item 8 is a vision zero update and you have a resolution that will be introduced today in support of vision zero and automated speed enforement that you will vote on at the next meeting. Thank you. Good afternoon commissioners. I am anna vislick with the Population Health division, and i am in the Community Health Equity Branch and copresent with my colleague in Environmental Health Leanna Schwartz and the Municipal Transportation Agency katie van gody and here to give you an update sorry. Thank you. Thank you. Give you an update on vision zero in San Francisco just as a refresher the goal is to reduce to eliminate traffic, fatalities in San Francisco by 2024. Vision started in february 2014 and gave yourself a ten year timeline because its an ambitious goal with a lot of city agencies and Community Based organizations at the table. We wanted to highlight where vision zero lives in the Health Department. It is in the Population Health division both the lead is out of Environmental Health, and Community Health equity and promotion plays a large role. Vision zero is the way we manage vision zero is through what we call the five es and the p. Im not going to read the entire slide but want to highlight some of the efforts that dph contributes so we cochair the task task force. Megan wier is on Maternity Leave and we have staff from the Municipal Transportation Agency and can answer any questions that you have but we address vision zero through the 5es but the one we want to highlight today is the policy initiative because we have a specific request for your support and a resolution to ask for some supporting state change in legislation for automated speed enforement which you will hear about later today. Just a summary of progress and just year in 2015 mta completed 30 projects to improve our streets and sidewalks in two years. That is no small feat and we have staff in the audience to answer questions that you have, and also we worked closely with mta on a campaign called it stops here. You can see a picture here on the side of the bus, and it was a campaign specifically focusing on having drivers yield the rightofway to pedestrians while crossing the street, and our team in Environmental Health did an evaluation of that campaign, which you may remember was in the chronicle. There was a 3 increase in drivers behavior yielding to pedestrians and thats a positive change in vision zero that we want to see and our team played a significant role in that but on the policy front the city unified around the idea making automated speed enforement the top policy goal for 2015 and adopted by the mta board and it was adopted by the Mayors Office as one of the top policy initiatives and were here before you today to bring that also forward. Lastly our team in Environmental Health developed this tool called the vision zero zero Injury Network. This may look familiar. We presented this before, and this is a our road map if you will on how we address vision zero. This is 12 of the street miles in San Francisco but well over 70 of all of the fatals and severs and this is the prioritization tool that we use here in this city to address vision zero, so the majority of the streets and sidewalk improvements and enforcement and education would be on these corridors and key intersections where we have a documented problem and i will bring up ms. Schwartz and will talk about the data pieces and vision zero. Thank you anna. Another dph lead project for vision zero that we wanted to highlight is the development of a transportation or comprehensive transportation related injury Surveillance System so currently San Francisco relies solely on Police Reported injury collision data to make all of our Traffic Safety decisions, all of the vision zero efforts, but we know that Police Reported injury collision data is incomplete. Not all injury collision data is reported to the police, and so what we have prioritized is linking with police data hospital level data, so as represented in this visual police data would represent this pink circle and hospital record level data would represent the green circle so really the power and strength of merging these two data sources together, which would include trauma registry data from San Francisco General Hospital, Emergency Service data and ems data that we increase our capacity to detect traffic injury and it means better Decision Making from the data and take the data and update our Injury Network which was shown in the previous slide and make sure were targeting and allocating our resources to the most dangerous intersections and corridors in the city. As you all know traffic fatalities are the primary metric for measuring progress with vision zero. This chart shows annual fatalities dating back to 2005. You see in San Francisco on average we have 30 traffic fatalities every year. As oona mentioned we launched vision zero as a city policy in 2014. We had 31 traffic fatalities. In 2015 we also had 31 traffic fatalities and so far in 2016 weve had seven traffic fatalities. This is through february which is our most current data. While engineering infrastructure changes, streetscape, redesigns and transformations are a key input vision we need to utilize other tools and we havent seen a reduction in traffic fatalities and why were seeking your support for automated speed enforement. Speed is a huge factor whether victims survive a collision with a Motor Vehicle. Also to note represented by the blue bar is the proportion of pedestrian fatalities and in San Francisco about 2 3 of traffic fatalities are suffered by pedestrians, and half of those pedestrians are Senior Citizens especially vulnerable population and growing population in San Francisco. So another key metric for evaluating progress of vision zero is severe traffic injuries and i quickly want to acknowledge our partners the San Francisco General Hospital the level one Trauma Center. We have a long standing relationship with the hospital and the trauma team there. We work closely with two trauma surgeons dr. Michelle [inaudible] and dr. Julian and their team to get the data and prioritize the Surveillance System and in an analysis we looked at one year trauma data we found that 515 patients had severe traffic injuries so that means an injury that landed the victim into the hospital for admission 24 hours stay or longer, so thats more than one or two incidents everyday. That is one person suffering a severe injury every 17 hours. Among the 515 patients one in five were Senior Citizens, 28 were children and the average length of hospital stay was six days. This is the number one reason people are visiting our Trauma Center in San Francisco. Continuing on among these 515 patients there were 16 that died. Half of the patients were pedestrians. As you can see in the pie chart to the right the transportation mode of the patients is shown. Over half of these patients were either pedestrians or cyclists who are most vulnerable road users and not only is there a high human cost to the traffic fatalities and injuries theres also an economic cost. Over half of these severe traffic injuries or these medical charges were billed to public funds. Another important issue that is addressed to vision zero is the issue of equity. Among the 515 severely injured patients 70 were male and the chart to the right shows some Racial Disparities found in the data so as represented with the red bar which is the racial distribution of San Francisco using census data you can contrast that with the blue bar which is the racial distribution of the severely injured patients and you see that blacks and historics are disproportionately impacted by traffic injuries in our city. While we accomplished a lot in 2015 we have a lot of work to do. I want to highlight some of these activities that we have coming in 2016. One of these programs is safe streets for seniors which just kicked off two weeks ago. Anna is leading that program but why were here today is seek your endorsement for automated speed enforement. This is a tool that we need to advance vision zero. As you saw with our traffic fatalities slide we havent had a reduction in traffic fatalities and we need to be utilizing all of the tools available, and that have been proven to be effective, so with that i would like to pass the presentation on to our partner katie from the San Francisco Municipal Transportation Agency who will speak more about automated speed enforement. Thank you. Thank you commissioners for having me. My name is katie and with the Government Affairs division at sfmta. As you noticed from some of our commitments for 2016 theres a Common Thread which is reducing excessive speeding so were using the three es, education and enforcement and engineering to reduce and manage excessive speeding but were pursuing the tools that we currently dont have, and the tools that i am here to talk about today is automated speed enforement. Its currently not legal in the state of california and were pursuing legislative changes to state law to authorize its use which is why were here today. So why are we focusing on speed . Speed is the strongest predictor whether a pedestrian or bicyclists hit by a vehicle will walk away from the collision alive. From the graphic the faster the vehicle is going the more likely that collision will result in a severe injury or a fatality, so a pedestrian struck by a vehicle traveling 20 miles an hour has a 90 of surviving while a pedestrian only has a 20 of surviving if that vehicle is going 40 Miles Per Hour and the chances of survival are even worse if youre a Senior Citizen over the age of 60. The chances of surviving goes down to 8 so fro tekting our vulnerable users such as seniors or small children or you know construction workers is one of our Top Priorities with this initiative, and so the legislation that we are proposing which restrict automated speed enforement units to areas to Senior Centers, to school zones, construction zones and then areas along the high Injury Network. And so speed is an issue in San Francisco. Looking at fatal traffic collisions in San Francisco over five years you can see the leading cause of fatal collisions account for about 25 , and about 20 of all severe injury collisions, so its more than any other collision factor and we also know its not captured in this chart, but through some Research Conducted by our partners at dph that speed is also largely a secondary collision factor in many fatal and severe injury collisions but officers can only check one box in a collision report which is a primary collision factor so it may say you know violation of a pedestrian rightofway but a loolt of spiem times speed is a factor as well so prior to pursuing this policy we looked to see what other cities were doing to manage their speeding problems, and we found that over 140 communities in 14 states across the nation had automated speed enforement programs and these communities realized reductions in speeding including reductions in excessive speeds so vehicles traveling over 10 Miles Per Hour over the speed limit, reductions in average speed, reduction in injury collisions and faitdal collisions, and also interestingly reductions in the amount of violations that were being given over time showing that these drivers were responding to this mechanism and changing their behavior. So just a lot bit about the technology. Automated speed enforement can be fixed so on a traffic signal similar to the red light cameras or they can be mobile in a van, and the Technology Uses two radar beams to measure the speed of the vehicle and if the vehicle is traveling above a predetermined threshold then that unit is triggered and a image of the license plate is taken so were proposing that threshold be 10 miles an hour over the speed limit so again were trying to target excessive speeding so if youre going 26 in a 25mile an hour and the speed limit is 25 miles an hour were not targeting you. We want to reduce excessive speeding because that is what is most dangerous. And we understand that with any new technology or program that theres going to be concerns which is why were here today to talk about this. We worked with the Controllers Office last year and they conducted best Practice Survey at six cities across the United States to learn more about their implementation practices and you know what obstacles they faced when implementing their programs so just learn more about it and make sure that we have all information that we can get to make sure that our program is successful, and so these were just some of the top concerns that we found through our partner cities was you know theres public concern that that automated speed enforement wouldnt have much of an impact but we found from studies, study after study and many studies are required by other authorizing state legislatures to report back on the effectiveness of automated speed enforement and so time after time proven to reduce speeds and severe collisions. Also issues related to privacy. You know were proposing that our system set up to only photograph the license plate so the picture of the face is not seen. Also that these photos would only or images would be only used for automated speed enforement and for no other reason and then they would be destroyed after a certain amount of time. Also revenue so this is not about its not about money and so we are proposing that any revenue that we receive from this program would be used to cover the cost of the program and then any additional would be used for Traffic Safety projects, and you know it would be great if we get this passed through the legislature and then we set up the program and we dont have to issue a single ticket. That would be great because it would show that people arent speeding on our streets which is our ultimate goal. People have also raised concerns about the technology, and we have proposed certain controls in place including routine calibrations as well as as fairness. You know why people why are you targeting me . These cameras arent targeting anybody. Theyre targeting vehicles going over a predetermined speed threshold and more objective way to enforce current speed laws, and also i just wanted to touch on some of the warning signs so there would be signs posted before entering a corridor thats enforced by radar and also at main entry points around the jurisdiction so if youre a tourist or visiting from outside city you will be made aware that we use automated speed enforement in the city and not to speed here, and so as i mentioned before it is currently not legal and prohibited in the california vehicle code so were asking for your support today for a Pilot Program in San Francisco, and its just really important to show our support to our state delegation. They expressed to us they would like to hear from the local community for support of this program, and we have received about two dozens letters of support and resolutions from local community groups, from the General Hospital Trauma Center as well as government bodies including the board of supervisors and so its really important for us to have the Public Health Community Behind this because it truly is a Public Health issue as youve seen from the presentation, and we thank you for considering this, and i invite my colleagues up if you have any other questions . And again just a reminder commissioners the vote is on the may 3rd meeting not today for the resolution. We actually have one public speaker first before we take questions. Cathy deluka from walk San Francisco. I will put three minutes on the timer and then your time is up. Okay. Thank you. I am the policy manager with walk San Francisco and first and foremost i am here here today to thank the department of Public Health and the commissioners for the strong support of vision zero and your work. San Francisco Department of Public Health is really leading the nation in terms of getting data that helps push vision zero. I was recently at the vision cities conference in new york city talking to advocates from lots of different cities and they kept talking about how hard it was to get good data on what is happening in the city in terms of traffic crashes and injurieses and i would look at them and i am new to walk San Francisco. Well, just ask your department of Public Health. They have all the data thats what they do. No they dont do that here so theyre scrounging to get the data but were leading the nation because of your efforts and staffs efforts over the last ten years to find out where collisions are happening and maps of the high injury corridors. The work that lay lanny is doing with this and finding out big the epidemic is of traffic injuries in the city and i want to thank you for leading the way and growing your efforts. I know the staff expanded on the work on vision zero. We urge you continue the expansion into the vision zero work and finally i dont know how much time i have left but i urge you to support this res for automated speed enforement and its a logical idea to go with this and the data and seed is the number one collision factor and we could use the data to precedent injuries and traffic injuries and i urge you to support that and thanks again for your leadership. Thank you. Commissioners questions at this point now to the presenters . Commissioner chung. First i want to really thank your presentations and also the effort of like looking at how we can tackle this issue. My sister actually almost got hit by a car years ago, and you know you know, on the alemany boulevard so thats actually my question and those high injury corridors, a lot of time its also in residential area, so what would it be like to set up all these automated like speed enforcing . So the legislation would you know create certain or restrict the use of the technology to certain areas. As i mentioned school zones and Senior Centers and construction zones and areas that have a high propensity of sever and fatal injury collisions so using the great data from the department of Public Health and probably based on the high Injury Network it would be data driven so we would see what corridors had high instances of severe injury and fatal collisions and that alemany is alemany on the high injury . [inaudible] commissioner chung are you asking what the cameras look like in residential areas . You know because the area exactly input whether they want these cameras. Like thats another process. [inaudible] yeah. I think yeah they look pretty similar to the red like camera, running cameras. Its kind of a box on top of the connected to the Traffic Signals. I dont instead of a Traffic Signals because oh, oh. Youre going to have these in different like different points. Yeah. [inaudible] off mic . Do you want to use the microphone so that the audience can hear you . I imagine the cameras are attached to a pole and the residents would be supportive of that in their community if they do have a High Frequency of speeders the. Its in a residential area where children or family members are using the street. I would imagine they would be able to work with the community. I just have seen models of what they look like and i am sure that if esthetics are an issue we would be able to work with the community. Yeah, i think thats the point because a lot of times its really not the functionalities of these like you know like resources. Its more about how they look in the neighborhood these days, and so i am curious about that. Also what is the process . So we have to go to the state legislature for them to pass legislation and do we have to come back to our own legislators to pass something here also . Yeah. So we would secure an authorror which could be one of the members of our delegation so member chiu, ting, the next senator or it could be someone from a different delegation so we were working closely with the city of san jose who is also interested in doing a Pilot Program so it could be any one of those member and they would propose it to the state to their state to the assembly or the senate depending who introduces it and has to be approved by the governor and we already got the go ahead from the board of supervisors to pass a resolution and this is one of the mayors top legislative priorities as well, so were all approved. Okay. Its a state issue at this point. I just want that cleared up and know what the process looks like. Yeah, thanks. Yeah. I was just going to follow up to ask where has been the opposition . Why is it that california and new york have not actually gone into this in terms of legislation already at the state level if it seems so obvious that this is a way to stop pedestrian well, just stop any injurys . Well new york does have automated speed enforement. It took them about ten years to get it, so our opposition is at the state level. The state level unions. One of our biggest opposing organizations right now is the teamsters and the triple a and then theres also Large Organizations that are concerned about privacy, so its mostly the state organizations. On the local level everyone has been very supportive. Its more you know getting a bill introduced and then getting it squashed in the first hearing because the teamsters make a phone call, so were working with the teamsters right now actually. Its been really productive and so we have been hearing what their concerns are and trying to incorporate those. My question was similar to yours. What is the substantive reason the unions are against this . So with the teamsters they so theyre concerned about their drivers getting more tickets. So the teamsters going 10 miles an hour after the speed limit theyre concerned they would get then get more tickets . It doesnt make sense to me. Im not saying it makes sense but i am curious. Yeah. If theres something to do with the data where someone was involved with the teamsters got injured that would be useful too. Yeah. We asked sfpd for information to see if the commercial drivers get speeding tickets and they werent allowed they werent able to provide that information. Right. Yeah. Well, keep up the good work. Did you say that the automobile the triple a was against it also whereas theyre out there trying to promote safety . I mean do they have logic what i am looking also within our resolution we could help address some of the issues if we have the data to back up what it is, so unless you can give us something substantial. I mean why would the triple a then say in appropriate places we should be able to slow down the speed when they seem to have a campaign to have safe driving . [inaudible] and Insurance Companies , right. Yeah, yeah. You would think they want their drivers to not get in collisions so we have it boggled my mind as well why theyre opposed to it. It doesnt make sense intuitively but i think theyre trying to represent the driver. The same thing with the teamsters and represent the members of the unions and not get more tickets for the drivers, and so i can think about some other language that we might be able to put in the resolution. Thats what i am thinking because at least address that as a you know, more strongly as a safety issue. We can certainly work with you on language to incorporate that at the next reading. One point we would like to make that we didnt say in the presentation these tickets would be decriminalized. If its issued by the cameras so its not a point on the license. This is the equivalent of a parking ticket and that that helps with the teamsters because theyre commercial and professional drivers so if they get a point on the record its not one point and its 1. 5 and puts them at a higher risk of losing their commercial license so thats another reason and we addressed that with no points on the record and also one of the requests was not allowing these cameras on freeways and so were fine with that because it doesnt really impact us and also they wanted to ensure that employees were running the system, and not vendors, and so thats what our plan was anyways, so just kind of working with them on those issues. They only should be on holidays and evening too. Uhhuh. Perhaps one of the things you have been saying and whereas we may be should have it within the whereases and think of it and one of the first questions in my mind too is there another way to get another point on our tickets and just like sometimes the stop light cameras are not functioning correctly and so forth. I could understand some of that. Maybe we could put something to help in indicate what the camera is used for is to discourage speeding for that reason that were not that it is not you know, its not a criminal offense or anything. Youre decriminalizing it, Something Like that, so those arguments fair people would look like and okay that takes away my problem. I think there is the issue and a ttputting up these big things on the sidewalks and picturing in front of my house and sidewalk and even though its the intersection and i dont want it blocking my sidewalk. I think that was part of the summary action in the neighborhoods about that, but i do think looking at how we could strength know our whereass to help argue the point. I mean its clear from at least the four of us well, i havent heard from the other commissioner yet. One thing that is incumbent upon us at the Health Department like in the fourth whereas i think that data is not significant and if it is we need to say that and if not we need to say that and we assert certain things that are data driven but the end are small in the data that you presented to us. And the fourth whereas and the department of Public Health of public injuries that one or the fifth . That one, the fourth. I think whenever you assert data our case gets stronger and significant and i know everything thomas does when he shows us studies relies on that kind of rigor. But that would be some of the specifics that would help i think as people are reading this and reading it as a support document that we would like to insert as much as possible what is actually going to help answer in the publics mind what they may questioning about this. Commissioner. Yeah, what was relevant for me is San Francisco general and the number of cases and Motor Vehicle related. I think its a significant number and from our county or not i dont think it matters. In regards to the specific resolution i feel this is very supportable from a Health Perspective. As a driver you have different thoughts but from a Health Perspective anything that improves lives and reducing trauma i think this is supportable. I actually have another question i would like to ask if you can give me a larger framework and based on my observation and some of the drivers that i know to come and love. Its gotten harder to drive in San Francisco. Some people feel its more dangerous to drive in San Francisco because of different notations on the streets and the signage and things. Its also probably not at the threshold yet that i feel necessarily feel safe about riding a bike as well and were still trying to get the bike safety and we know that walk safety is difficult so getting places is hard so where does this fit into the larger picture moving towards safety . I see this as one effort. I dont know if this will reduce us to zero and i dont know if you expect that as well but a significant move forward. What would be the next step after that that we need to be thinking about . I am going to support this but thinking in terms of the larger picture to have Real Solutions in making our cities feel safe both for drivers, pedestrians, and bicyclists. Whats the collective impact strategy that you think we will need next . [inaudible] off mic as we talked about earlier we have the five es and the p and we focus on the p today, the policy. We have a large scale Education Campaign that were working very closely with mta to achieve a sort of a culture change around Traffic Safety and vision zero. This isnt about teaching people how to look left, right and left again. This is talking about this is the problem in San Francisco. We all play a part in this solution, and these are all the Different Things that need to happen together to do that. There are some really large scale Construction Projects coming up and i will let mary talk about in a second but we have a real exciting police department. They are working on a you will see the new technology and instead of hand written tickets theyre doing a pilot how to Issue Citations electronically to reduce error and be more efficient and that is going to be launched this year as well, and then we have all of our wonderful work with our team in Environmental Health who is doing all of the evaluations, so theres a lot of pieces to the pie that were working on in vision zero and i will let maury talk. Just quickly as anna described it is a multipronged approach to a very significant issue here in San Francisco, so among engineering and evaluation and education and enforcement we know we cant engineer our way out of something and educate ourselves out of something and looking at these efforts and in the engineering efforts they too if necessary have the enforcement component, have the education component and then we can evaluate, so were in the second year of a two year Action Strategy which includes tests for all of these items, and we already know that some things have to change. As youve heard the numbers havent gone down. Its an iterative process. We set a goal of ten years and we will continue to work towards that, and ase is one of the tools to reach that but with respect to engineering coming from the sfmta using the high Injury Network map we are developing our Capital Improvement program, all of the Capital Projects to prioritize those corridors, but in addition we want to of course make the streets safer citywide and regardless if someone is from the city or coming to visit or from a nearby you know east bay, north bay, south bay we want everyone to have a safe experience traveling through whether walking, biking or driving and its about bringing all of the things together. Its relatively new here in the states so we have great examples internationally and were borrowing best practices from both them and Partner Agencies across the nation, so i am feeling i am missing from this or some of the efforts i am interested in branding our city in a way that transportation makes sense, so for example los angeles is a driving town. Regardless how you look at you have to drive to get somewhere in l. A. Portland and seattle are those kinds of town and new york im not sure its a vision zero town or a safe town. How am i supposed to get across town and how does it translate into the policy that we just had a resolution . Again the resolution from a Health Perspective makes sense, but a coherent transportation strategy and a vision of that really translates into everybody feeling this is the way to get around. I think its around having a green vision, a healthy vision. I think that certainly is very much in line with San Franciscos ethos, but it would be nice for me to begin seeing some of that as part of the branding of this because i think thats what is going to keep me as a citizen thinking how i drive and how i should be moving about, so otherwise i am looking at a lot of stop signs and flashing things and lights telling me what not to do but i am looking for things what to do well and be a safe transporter. Sure, sure. And that has come with new safety treatments. You know the green bike line some people have never seen them before and yay another half lane for me to drive in. They dont understand how to use those necessarily and that is part of the education process and teaching them what they are and with respect to what you should be doing and how to get across town. Another vision zero is the priority for the sfmta but mode shift. We provide transit and biking infrastructure and other infrastructure and we want people moving towards those so those priorities go hand and hand and we want to make sure were building the safest network for people to choose those modes of transportation. Have we thought about a healthy transportation campaign, be healthy when youre moving around, as part of the healthy part of the obesity campaign. [inaudible] commissioner pating. That is in the preplanning stages right now. Mta is leading that. There is a large scale campaign. Im on the committee for that effort and you should begin seeing some branding and communication collateral and materials coming out by the summer or the end of the year and i am happy to come back with the team and give an update on vision zero and include that messaging particularly, but that is on the docket for this year. Mta got a significant add back from the Mayors Office and the supervisors to develop the exact materials youre talking about. Good. Because i bought a new pedal scooter and looking to try it out downtown and i need a place to be safe. [inaudible] my only reflection on this is in discussion kind of the pragmatic politics of this that you face in the state legislature is that i cant believe im doing this. But my dad gave me advice dont be so open minded that your brain falls out and by that we shouldnt be embarrassed that we give tickets and be shy and points for speeding because of the injuries it causes. I mean the data are compelling. The thought that you guys have put into this in the other cities has been detailed and care, and you know we got a good point so lets not water it down so much so it doesnt matter. You know these kinds of injuries change peoples lives. Forget how expensive they are. They really change peoples lives for the worse so i think we ought to go for it. Like we shouldnt be embarrassed about it. Yeah, i appreciate your comments. I think the only the reason were watering it down because we were trying to find something that would passthrough the legislature, and i dont have to worry about that sitting up here. Yeah. You continue to do this the next thing theyre going to say well, we dont want electricity in the cameras because then they will work. I just think were trying to do good things for our city, and we awtd not to let forces talk us from the logic. And correct me [inaudible] off mic be more acceptable to some of the delegation and the opposition. Right. Commissioner chung. I appreciate you mentioning that this is a multiprong approach, and you know like so far we have heard about the Pedestrian Safety and how we are trying to make it safer for pedestrians. Weve changed like cyclists like safety by implementing it is green bike lanes and this seems like a Harm Reduction model for trying to reduce. The fatalities but the data shows that 30 of the fatalities was a result of like speeding so what are the other 70 . What are we going to do with the other 70 . Is this the slide youre talking about . [inaudible] off mic . So commissioners i think its quite clear from the discussion that we are looking at accepting this resolution resolves but looking at strengthening it, and i think as commssioner singer says you can also use real data here. I mean youve got data showing 38 including the pedestrian right of way right there is a cause of these traffic accidents, you know. Theres just a number of things that i think can strengthen it so we can have a stronger resolution for you in terms of moving our endorsement of the agenda. Absolutely and we will work on that in the next couple of weeks and get that to you in time for the may 3 meeting, absolutely. Thank you. Are there any further comments at this point . Thank you. I have not we havent done Public Comment on this. You have another meeting but lets look at a new resolution to be more specific and help you move this at the legislative level. Thank you. I appreciate it. Thank you very much. Next item please. So we move on to item 9 which is the 2016 Community Health assessment and this is a resolution in support of the Community Health assessment that will be introduced today and voted on the may 3, 2016 meeting. Good afternoon commissioners. My name is michelle currian and i am happy to be presenting today on the 2016 Community Health assessment. I am with the Community Health assessment impact unit of the department of Public Health Population Health division. First off what is a Community Health assessment . So the Community Health assessment provides a foundation for improving and protecting health by systematically identifying and describing Health Status of the community as well facts that impact health. The 2016 Community Health assessment collected information on healthy san franciscans via three methods, Population Health data sorry, Population Health data analysis, assessment of prior assessments, and Community Engagement. At the conclusion of these three Elements Health needs were then identified by committee. While the 2016 Community Health assessment is the city second its the first that the Health Department completed in collaboration with our partners entirely internally. As youre aware in 2011 the Health Department embarked on a journey to obtain Public Health accreditation. Community health sorry, completion of a Community Health assessment is a requirement of accreditation at least once every five years. Accreditation however is not the only driver of the Community Health assessment. Many city agencies, institutions and organizations are required to assess the Health Status of their groups. With a shared vision to promote and improve the health of our san franciscans we partnered with the nonprofit hospitals via the San Francisco Health Improvement partnership to create a unified Health Assessment and therefore reducing redundancy of efforts and better alignments of efforts to improve health. The Community Health assessment provides a foundation for each of the nonprofit hospitals, required Community Health needs assessments as well as inform the San Francisco Health Care Services master plan. The department of Public Health will work with the hospitals and the Community Partners to develop a Community Improvement Community Plan which addresses some of the needs identified in this assessment. Alignment to the this requirements necessitates that we complete a Health Assessment every three years instead of five. The first element of the 2016 Community Health assessment was examination of secondary quantitative Population Health data recognizing the essential role that social determinants of health play we examined data describing the conditions which san franciscans are born, grow, live, work and age, and individual risk and protective factors as well as disease and death rates. The modified bar high framework shown here was used to guide the breath of variables to be included. Specific variables were then identified by cross referencing data with national and state and indicator projects such as Healthy People 2020, the cdcs Community Status indicators and Community Health rankings. Potential variables were ranked on results based management criteria of data power, proxy power and communication power as well as the ability to examine Health Inequities and current use by our stakeholders. In all 177 variables were analyzed. The results of those are included in 28 data sheets. Where appropriate analysis include information on race, age, sex and place and ethnicity. The second element of the Community Health assessment was an assessment of existing assessments. As we designed the Community Engagement process we heard from Community Representatives that many residents felt over assessed and under served. We were afraid to offend and disrespect these residents as well as we recognize this being an excellent data source so we did this assessment of a prior Community Health assessments. The goals were to see which communities were prior assessed what analysis were done and the findings from the assessments. In total we collected 46 assessments and screened them. Of the 21 are inclusion criteria and included in the analysis. This criteria included having Data Collection after 2010. The third collection method was Community Engagement had three principle goals. The first was to identify san franciscans Health Priorities especially those with vulnerable populations. A second was to obtain information on those populations for which were lacking information, and the third was to build relations with the community. Using information garnered from the assessment of prior assessments and the Population Health analysis we identified target populations which we knew had Health Disparities or had little data and not included in the recent assessment and which we could actually reach through existing community organizations. Overall Community Engagement was small. It included a total of 127 participants in 11 meetings. However, our approach did allow us to meet with residents from varying backgrounds who might not have been likely civically engaged. The Data Collected through the 2016 Community Health assessments and the Health Priorities identified in the 2012 Community Health Improvement Plan were reviewed by the San Francisco Health Improvement Partnership Members who determined the health needs. The San Francisco Health Improvement Partnership Includes representatives from the Health Department, the nonprofit hospitals, the clinical and translational science institutes Community Engagement and policy program at ucsf, the San Francisco unified school district, the office of the mayor, the Community Clinic consortium, face base and Philanthropic Partners as well as Community Representatives from the asian and Pacific Islander parity coalition, Human Services network, the chicana [inaudible] and the africanamerican Community Health council. Participants identified health needs through a multistep process. The first was review of data via presentation, data sheets and a data summary. If it is that we had Small Group Discussions and had a workshop. For the entire process it was defined as a Health Outcome of morbidity or mortality or Behavioral Health services, Clinical Care and factors that impact well being. To be a healthy outcome or contributing factor needs to be [inaudible] low audio and for the defined benchmarks were pulled from national or city estimates or healthy 2020 targets where available. The assessments itself served as benchmarks for examining population data. Overall the 2016 Community Health assessment found that health is improved in many ways in San Francisco. For example, more than 97,000 residents gained Health Insurance under the Affordable Care act in 2014 and had steady declines in hiv diagnosis and the rates of death due to complete speaker cards and documents to be part of the file should be submitted to the clerk disease, cerebral diseases and decreased in cancer has decreased want however, the assessment did identify two foundational issues, economic barriers to health and racial Health Inequities as well as seven health needs. The seven health needs are psychosocial health, Healthy Eating violence prevention, access to coordinated and lings qiftally services across the continuum, housing stability homelessness and Substance Abuse and physical activity. The foundational issues which can be viewed as cross Cutting Health needs were highlighted by the committee as these broad topics affect health at every level. The committee noted that improved health for all in San Francisco requires planning which integrates consideration of these issues. Data described in each of the foundational issues and health needs are provided in the assessment as well as the data sheets in the appendixes. The 2016 county Health Rankings released last month corobbate our findings and the overall ranking increased from 2015 to 2016. San francisco performed poorly relative to other california counties on a number of issues including excessive drinking, income inequality, High School Education and Violent Crime and injury deaths. Our final steps for the 2016 Community Health assessment are to address any remaining typos and errors and incorporate any changes you suggest. Over the next weeks we will make edits but i do not expect major changes. As an example one that was brought to my attention in table 11 in the demographics appendix. Here a word omission and a title lead us to say we projected population of 294,000 instead of population change of that amount. We dont expect any catastrophic changes in population. The next major step for the department of Public Health is to update the Community Health Improvement Plan, identify the assessment will be prioritized and objectives and strategies to adopt the health needs and this work is ongoing and expected to be complete mid2016. Again i want to thank you for having me present today and i want to ask if you have any questions. [inaudible] off mic . Thank you. [inaudible] off mic . Thank you very much. [inaudible] off mic . I have not received mic but i would like to note that commssioner singer has to leave by six and you have a halfhour to ask questions. [inaudible] off mic one of the things [inaudible] i think also important for us to acknowledge as part of the work that we need to do [inaudible] there are a number of parameters were not at that we should be in terms of our own level of say level of activity and that goes all the way from the question of continued rising rates in the syphilis rates for tuberculosis [inaudible] but its in the data base but the process doesnt seem to allow that we would look at those as also being as important as some of the things impacting health. I mean just sort of absent all the way down psychosocial [inaudible] anything that talks about trying to address the known disparities [inaudible] off mic high syphilis rates [inaudible] and maybe its a process that doesnt actually able to acknowledge those are also very key factors that are important as we look at the health of the community [inaudible] off mic . Okay. Yeah. So identified health needs dont show absolutely every small data point in which we may not perform well. Theyre broad categories, and in the into graphics we point out some of the data points that support those and i know that as the Health Department were not going to stop working on the Communicable Diseases and we have robust programs on them at the same time when looking at death data the top killers are all chronic diseases, and so we definitely can look at the process to make sure that it is open to all of the health needs. [inaudible] off mic report card and in fact in those days determined that certain things would be objectives [inaudible] i am just saying [inaudible] medical health doesnt show up in the context [inaudible] off mic Community Health is very important down here [inaudible] so im not sure how to capture that. Im not saying this an inappropriate document for planning but is there some recognition there are other factors that are really important that are also going to be priorities for us . Right , right. [inaudible] even Health Assessment programs [inaudible] so this is a citywide Community Health assessment, and then it identified some specific needs at a city level. The next thing that is going to happen is bringing together the diverse stakeholders to come up with a Community Health Improvement Plan that will have more specificity on as a city what areas we want to address. Now, the other thing thats going to happen additionally is as the Population Health division also develops a Strategic Plan thats even broader that addresses those things in the Community Health Improvement Plan or chip or broader priorities so if you go back you probably dont remember but remember we have a Strategic Plan and we have a cross cutting initiative, so there is a bigger plan and the other thing to realize is that our Strategic Plan has to have some focus and specificity in terms of addressing the things that have the highest burden of disease, and so we need that for Public Health accreditation but our foundational activities never go away, so our core Communicable Disease for all of those diseases, tuberculosis, std et cetera as well as all of the Environmental Health activities so what you will be seeing is really a subset of all the things that we do but there are other documents when you put them all together paint the complete picture, but [inaudible] off mic . Yes. This is just the assessment, Community Health Improvement Plan and you will see a new plan and strategic and again theyre high level and there are hundreds of things that the division does and you get updates through other means of std and tuberculosis et cetera. [inaudible] well, first of all the appendix is just wonderful. I went to sleep reading it and quizzed my wife saying guess how many of this in each district . It was a fun exercise and how well we can know our city and felt like a manual to San Francisco living and i want to thank you for that. No. I actually liked what dr. Argone said at this point and the chip is a subsection of the health plan and the question is how we would be hearing that data . And we can hear that at the Community Health subcommittee how the larger ph. D plan is brought up. I like the health needs. I was hoping the violence and prevention would be on the target and given were 49th or 57th, 58th county in california of violence in some neighborhoods so really glad of that and i hope the issues around homelessness are not just around housing and i see Mental Health and Substance Abuse are in there and i think thereby a lot of Integration Services when we get to the actual plan. I realize this is just the Health Assessment so the question is sorry for the prolong. How long is the plan and how long will it last . We do it every few years i understand. Its due out mid2016 and the group is currently working on it, and whether its going to be updated probably to reflect the timeline that the Health Assessment is on which is about every three years due to the alignment with the irs. So as you present the plan to us it would be nice to see things that were in previous plans that maybe we now decided we met goals or are less important so it might be success. And the new plan and going to see how things change. [inaudible] off mic part of the total programs of the department and [inaudible] as stated here and then becomes the only document [inaudible] i wanted to acknowledge commissioner chung had a question and i will go after. [inaudible] so this is like deja vu and i think when i was first appointed to the commission i had the privilege to attend a lot of the Community Meetings chip, right, the other meetings they went to were hip and i get confused with that and the chip and the hip and i want to say its really amazing. We just had the vision zero presentations. I remember these conversations vividly it came from the community as well, you know, about Pedestrian Safety, about you know like having more organic food in grocery stores, so like to me i definitely feel and think that you know like those process has translate to actual policy work here that the community was prioritizing, so kudos to you, so what i am seeing now is that were trying to build on the last plan and you know add some new policies and you know new priorities to it. Is that correct . Yeah. They did take into consideration that the previous 2012 chip that was definitely it may be reorganized a bit but some of those priorities are [inaudible] yeah. I would hate to see that we start a conversations from the beginning again, you know, when theres so much work being put into it. The question i have is youve identified language needs, you know, like spanish and chinese and since chinese only accounts for 18 of the asian populations. What are some other languages . Do you have any thought into what like languages that we need to prioritize for our communities . Im not prepared to answer that in detail right now. We do have a list of more than the highest ranking languages that are spoken in San Francisco in the appendix so if there was yeah, i dont know which table to refer you but it says the more common languages and we can certainly yeah, one other thing i want to point out with the graph of like ethnic composition i think you counted asian twice because you said api and asians. I assume that is Pacific Islanders and asians. I will be sure to check on that. [inaudible] yes, one of the things that were really excited about is because all these stakeholder come together like the hospitals, us and if you go across the country its not like this and its fragmentd and not all of this collaboration and because were able to come together with a collective vision allows the hospitals as they invest in the Community Benefits to align with this common vision and its also helping philanthropy, the grant makers funding Health Priorities that they have a framework in priorities. Were all going to be working for the same play book from my perspective is exciting and powerful and i wanted to share that with you. I just wanted to add to that and acknowledge our deputy directive colleen chela who helped frame this as well because you could have four different plans coming in front of you, and so weve did dr. Argone and michelle great work and it was awkward for the groups to sit together and they got through that and its been a great process for them and this also solves so many of the requirements for so many of the groups and as the doctor said its collective in that whole role collective path starts with the data and also the understanding of what the Health Status and thats the foundation of the department of Public Health is to assess the health of the community and i want to thank them all for a great job. Yeah. I want to thank you as well and i think its super helpful in many ways, scmi think our challenge from the plan and then to implementing it is making sure that the resources of the department are deployed in a way that reflects the conclusions of the department what are our biggest challengings, and i think its hard to do for a couple of reasons. One, we tend to make decisions serially and we get in terms of spending on programs, and we frequently have an ability to actually put it in the context of the wider spend, and this really gives us the opportunity to do that, so that we can actually go after things rationalely, and thats very hard to do in the context of so many stakeholders, the power of inertia in an organization like ours, not because anyone is equal but the reality of life and i am looking forward to the net set of discusses to see the connection of what is laid out here and how we actually deploy our resources. [inaudible] off mic . Yeah. And so i think [inaudible] off mic . Right. Then the next key document that is coming is the chip, the Community Health Improvement Plan and will link [inaudible] off mic . Right, right, right. Exactly. May i ask in regards to the hearing, the presentation maybe presenting to the commission we could be within that cqi cycle so what were the lessonsern laed in the last plan and the last assessment and tying this presentation in and saying where we ended up and Lessons Learned and what we learned and new changes and add to the continuity and this isnt a new assessment. You have been working on these issue issues for a long time and in the historical sense and refresher and given the complexity of your capacity to solve these problems. [inaudible] thats my pet peeve almost in every report is i understand that sometimes because Transgender Community is not large enough to make a significant, you know, like data point in these datas, but it would be helpful you know at least as an explanations why when we look at you know different Mental Health and all these other physical health, its only being categorized by male, female and not without articulating the reason why some are being left out, yeah. Yeah. We can better know definitely in the Sexual Health section and other relevant areas where we have omitted data due to data stability issues. But i assume this problem will self correct later on in time with aca implementation and within other Data Collections were doing. Yeah. I hope so and i want to note in the Community Engagement transgender was one we reached out to and they participated. [inaudible] off mic . Oh in any instance where we had zip code data we didnt place it in the neighborhoods as you theyre not mutually exclusive but we presented that as zip code data and neighborhood data would be at the census track and rolled up evenly into neighborhoods. If we created neighborhood profiles we would definitely if we translate the zip code data into a neighborhood we will provide you that. [inaudible] off mic and depending where they live and what it was i mean we werent sure what categories we were in, and i am in east valley or castro or market . Maybe its just the map we need to find out how you draw these. In addition a key to the map and cross referenced easier. [inaudible] got it. Sure. Sorry to make this go longer here but commenting on that particular draft it is such a useful tool. I can imagine from a Research Perspective and citizens perspective and wont remain static and some of the state data systems its open and you can do public queries of that data base and by zip code, hypertension rates and stress rates and alcohol rate and if youre doing research on an issue a Wonderful Public Service tool. Getting this on real time server whatever quarterly intervals you could update it. Its such a wonderful tool that i hope you continue to make this Data Available and if we could make it real time it would be so much better. I am very, very pleased. For me that was worth the price of the report was the appendix you produced. Yeah. Its definitely in our interest to go from the report format and something more interactive and as we involve yourself. [inaudible] commissioners and because we have a lack of time i am suggesting that you all take the rest of the categories and report out. There is no reporting except for item 11 and postpone that until the next meeting. That is fine. Is there any objection . So motion for adjournment is in order. Motion to adjourn. Second. Second. Okay. All in favor of adjournment please say aye. Aye. All opposed . The meeting is now adjourned. [gavel]